Season 7 | Episode 14
In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Gulcin Benbir, professor of neurology and sleep researcher from Turkey, and Dr. Lourdes Del Rosso, sleep physician and professor at UCSF who served on the task force for updated AASM RLS guidelines, to discuss groundbreaking research on periodic limb movements in sleep (PLMS) that persist after successful sleep apnea treatment.
Following the recent updates to RLS guidelines, this conversation addresses the often-overlooked condition of periodic limb movement disorder (PLMD). The guests reveal surprising findings that challenge traditional teaching: while sleep medicine practitioners have long been taught that PLMD improves with PAP therapy, their research shows that 30% of patients continue to experience significant periodic limb movements even after successful OSA treatment.
The discussion explores critical clinical questions: Are PLMs innocent bystanders or pathological processes requiring treatment? When do PLMs become PLMD? How should we evaluate residual hypersomnolence in well-treated OSA patients—should we screen for persistent PLMs before prescribing wake-promoting agents? The experts also delve into the complex relationship between RLS and PLMs, examining whether they represent interconnected sensory and motor phenomena or distinct processes.
Practical treatment strategies are covered extensively, including the role of iron supplementation, appropriate diagnostic testing, IV iron protocols, and evidence-based pharmacological interventions. The conversation also addresses how the shift toward home sleep testing may impact our ability to detect and treat this important cause of continued sleep disruption.
Whether you’re treating OSA patients with persistent daytime sleepiness or managing complex sleep disorders, this episode provides essential insights into recognizing and treating PLMD as a potential contributor to ongoing symptoms.
Join us for this clinically relevant discussion that may change how you approach residual hypersomnolence in your practice.
Dr. Gulcin Benbir
Dr. Gulcin Benbir Senel is a Professor of Neurology and leading sleep medicine researcher at Istanbul University-Cerrahpaşa, where she serves as Head of the Division of Clinical Neurophysiology. She completed her medical degree at Marmara University English Medical Faculty and her neurology residency at Istanbul University Cerrahpaşa Medical Faculty, with additional training as a visiting fellow at Stanford University’s Sleep Laboratory. Dr. Benbir Senel has established herself as a prominent figure in international sleep medicine, serving as a board member of the International RLS Study Group, member of the International REM Sleep Behavior Disorder Study Group, and scientific panel member of the European Academy of Neurology’s Sleep and Wake Disorders division. She founded and serves as President of the Turkish Narcolepsy Network and is Editor of the Turkish Sleep Medicine Journal. With over 110 publications in SCI/E indexed journals and extensive research experience spanning multiple sleep disorders including RLS, OSA, narcolepsy, and RBD, her work focuses on the neurophysiological mechanisms underlying sleep disorders and their relationship to neurodegenerative diseases. Dr. Benbir Senel currently leads numerous international research projects investigating inflammatory pathways in sleep disorders, novel therapeutic approaches for RLS, and the complex interactions between sleep and neurological conditions.
Dr. Lourdes Del Rosso
Dr. Lourdes DelRosso, MD, PhD, MS, is a sleep physician and professor at UCSF. She earned her medical degree at the University of Miami, completed her family medicine residency at Kaiser Permanente through UC Irvine, and her sleep medicine fellowship at Louisiana State University. She holds additional advanced degrees including a master’s in medical education from the University of Pennsylvania and Valencia International University in Spain, and a PhD from the University of Portsmouth in the United Kingdom. Dr. DelRosso is a leading expert in restless legs syndrome and restless sleep disorders, serving on the task force for the updated AASM guidelines for RLS treatment and leading an international task force to establish diagnostic criteria for restless sleep disorder. She is actively involved in the American Academy of Sleep Medicine, where she chairs the International Members Taskforce and serves on the AASM Scoring Manual Editorial Team. Dr. DelRosso has made significant contributions to sleep medicine literature as lead author of “Pediatric Sleep Pearls” and editor of “Sleep Neurology: A comprehensive guide to basic and clinical aspects.” Her research focuses on restless sleep and restless legs syndrome, and she has been involved in global sleep health initiatives including serving as co-chair of the World Sleep Day committee.
